. On the origin and progress of renal surgery, with special reference to stone in the kidney and ureter and to the surgical treatment of calculous anuria. Together with a critical examination of subparietal injuries of the ureter . arenchymal degeneration about nephrotomy wounds dependschiefly on the size of the vessels divided ; and if this be so, itis a further reason for making the incision, as Gerdy advised,along the convex margin. After removing a calculus from the renal pelvis, if theconvex border has not been incised, the interior of thekidney should be palpated either through the openi
. On the origin and progress of renal surgery, with special reference to stone in the kidney and ureter and to the surgical treatment of calculous anuria. Together with a critical examination of subparietal injuries of the ureter . arenchymal degeneration about nephrotomy wounds dependschiefly on the size of the vessels divided ; and if this be so, itis a further reason for making the incision, as Gerdy advised,along the convex margin. After removing a calculus from the renal pelvis, if theconvex border has not been incised, the interior of thekidney should be palpated either through the opening, or, * Gerdy, P. 1ST. : Anatomie des Formes Exterieures du Corps Humain (Paris, 1829). See note on page 153. t Arehiv f. klin. Chir., Von Langenbeck, 1893, xlvi., 418. 124 HUNTEIIIAN LECTURES. if this be too small to admit the finger, then by invaginatingthe infundibulum. I have taken out some very large stones, weighing between800 and 900 grains, through incisions in the dilated infundi-bulum, large enough to admit readily the tips of two such cases an incision in the convexity of the organ forexamination purposes, is quite unnecessary. In some cases,indeed, the calculus is so bound down into the renal cavity. Fig. 28.—The same kidney as shown in Fig. 27, seen from within to show an uric-acidcalculus impacted in pelvis and bound down by dense fibrous bands. (WestminsterHospital Museum, No. 828.) by thick fibrous bands between the calyces that its extractionwould be most difficult through an incision in the feTiai—substance, whereas it is readily pulled out through the in-fundibulum. (See Figs. 27 and 28.) I have repeatedly extracted calculi through the anterior aswell as through the posterior wall of the renal pelvis withouta drop of urine subsequently escaping through the loin result may be safely expected provided the renal openinghas been closed by Lembert sutures passed transversely. If sutures are not used it is better, if convenient, to open
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